Medications and Drugs
Pharmacy Author: Omudhome Ogbru, PharmD
Medical and Pharmacy Editor: Jay W. Marks, MD
GENERIC NAME: isosorbide dinitrate
BRAND NAMES: Isordil Titradose, Dilatrate-SR, Isochron
DRUG CLASS AND MECHANISM: Isosorbide dinitrate is in the class of drugs
called nitrates and it used for treating and preventing angina or heart pain.
Other nitrates include nitroglycerin (Nitrostat, Nitroquick, Nitrolingual,
Nitro-Dur and others) and isosorbide mononitrate (Imdur, Ismo, Monoket).
Isosorbide dinitrate is converted in the body to isosorbide mononitrate which is
the active chemical.
Nitrates are vasodilators (dilators of blood vessels).
Blood returning from the body in the veins must be pumped by the heart through
the lungs and into the body's arteries against the high pressure in the
arteries. In order to accomplish this work, the heart's muscle must produce and
use energy ("fuel"), and this requires oxygen. Angina pectoris (angina) or
"heart pain" is due to an inadequate flow of blood (and oxygen) to the muscle of
the heart. Nitrates, including isosorbide dinitrate, correct the imbalance
between the flow of blood and oxygen to the heart and the work that the heart
must do by dilating (expanding) the arteries and veins in the body. Dilation of
the veins reduces the amount of blood that returns to the heart that must be
pumped. Dilation of the arteries lowers the pressure in the arteries against
which the heart must pump. As a consequence of both effects, the heart works
less and requires less blood and oxygen.
PRESCRIPTION: Yes
GENERIC AVAILABLE: Yes
PREPARATIONS: Tablets (sublingual): 2.5, 5, 10 mg. Tablets (immediate
release): 5, 10, 20, 30, 40 mg. Tablets (extended release): 40 mg. Capsules
(sustained release): 40 mg
STORAGE: Isosorbide dinitrate should be stored at room temperature, 15-30 C
(59-86 F).
PRESCRIBED FOR: Isosorbide dinitrate is used for the treatment and prevention
of angina caused by coronary artery disease. Only sublingual tablets are used
for immediate treatment of angina because the onset of action of oral isosorbide
dinitrate is not fast enough. Isosorbide dinitrate sometimes is used for
treating congestive heart failure.
DOSING: Isosorbide dinitrate tablets can be taken with or without food. The
sublingual tablets should be dissolved under the tongue and should not be
crushed or chewed. Tolerance (reduced effect after several doses) may develop,
so a drug free period of at least 14 hours is recommended. The recommended doses
of isosorbide dinitrate are:
- Tablets: 5-40 mg 2 or 3 times daily
- Tablets: (sublingual): 2.5-10 mg
- Tablets:
(extended-release) and capsules (sustained-release): 40-80 mg once or twice
daily.
DRUG INTERACTIONS: Sildenafil (Viagra), tadalafil (Cialis) and vardenafil
(Levitra) increase the blood pressure lowering effects of isosorbide dinitrate
and may cause excessive blood pressure reduction. Patients taking isosorbide
dinitrate should not receive sildenafil (Viagra), tadalafil (Cialis), or vardenafil
(Levitra). Severe blood
pressure reduction, especially when changing posture, may occur when isosorbide
dinitrate is combined with calcium channel blockers, for example, diltiazem
(Cardizem, Tiazac, etc.) and verapamil (Calan, Verelan, etc.) which also reduce
blood pressure.
PREGNANCY: There are no adequate studies of isosorbide dinitrate in
pregnant
women.
NURSING MOTHERS: It is not known if isosorbide dinitrate is excreted in human
breast-milk.
SIDE EFFECTS: Headaches are the most common side effect and usually are
dose-related (increase with higher doses). Flushing may occur because isosorbide
dinitrate dilates blood vessels. Isosorbide dinitrate may cause a drop in blood
pressure when rising from a sitting position (orthostatic hypotension), causing
dizziness, palpitations, and weakness. To reduce the risk of these side effects,
patients should rise slowly from a sitting position.
Reference: FDA Prescribing Information
Last Editorial Review: 2/20/2009
Report Problems to the Food and Drug Administration
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.
- Drug Interactions - Learn about potential drug interactions you may be exposed to. Drug interactions can occur with prescription drugs, OTC medication, vitamins, herbs, and supplements.
- Congestive Heart Failure - Read about congestive heart failure symptoms like fatigue, abdomen, leg and ankle swelling, shortness of breath, sleeplessness, increased urination, nausea, abdominal pain, and decreased appetite.
- isosorbide mononitrate, Imdur, Ismo, Monoket - Information on the drug isosorbide mononitrate (Imdur, Ismo, Monoket), a nitrate used to treat angina pectoris (heart pain, chest pain). Side effects, drug interactions, and warnings and precautions are included in the information.
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